Plastic surgery was once a very taboo subject - many people openly disapproved of procedures like facelifts or breast augmentations, and wouldn't hesitate to make their opinions known when talking to someone who had gone under the knife.
Your body, your privacy
You may not want your plastic surgery to be the topic of discussion around the water cooler at the office, which is perfectly fine. Many people choose not to disclose the purpose of their leave of absence for work if they're taking time off for tummy tuck recovery or something similar. Additionally, patients may request that their doctor strive to give them a natural or organic look, so when they do return to the working world they aren't turning heads with every move they make.
While one should never feel obligated to reveal their medical choices with anyone but their doctor, when it comes to loved ones like spouses, it may be best to give full disclosure. Most invasive procedures like rhinoplasty or a breast lift will require a patient to spend time recovering, which will be hard to explain away. Rather than make up some excuse for why your face is all puffy and you need to spend a week in bed, consider coming out with the truth, even if you think your loved one will disapprove of your choice.
A calm conversation
If you think your spouse wont' be supportive of your decision to go under the knife, then it's up to you to have a calm, rational discussion about your choices. Beforehand, make a list of the reasons why you want to make changes to your appearance. Your loved one may have an easier time understanding your choice if he or she knows that you're doing it to help your self-esteem rather than get attention, as may be assumed.
If your loved one is still nervous or has more questions, then you can invite him or her to accompany you to your consultation with your aesthetic surgeon. A professional in the industry may be able to put your spouse's mind at ease by explaining the procedure and potential benefits it carries.